HX64082601 

QM117.P95  Some  observations  on 


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Columbia  SSnttJem'tp 

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College  of  ^tjpgicianss  anb  ^urgeong 
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http://www.archive.org/details/someobservations03pryo 


Bulletin  of  the 

University  of  Kentucky 

Lexington 


From  the  Laboratory  of 

Anatomy  and  Physiology 


PUBLISHED  BY  THE  UNIVERSITY 


Vol.  VIII  NOVEMBER,  1916  No.  11 

Entarad  m»  Second  Class  Matter  at  the  Post  Office,  Lexington,  Kentucky,  nnder  the 
Act  of  July  16. 1894. 


':?o"ltnn:'^ 


Some  Observations  on  the  Ossification 
of  the  Bones  of  the 


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By  J.  W.  PRYOR,  M.D., 

Professor  of  Anatomy  and  Physiology, 
University  of  Kentucky. 


University  Press,  Lexington. 


1.     M.  B.— Female,  1  year,  2  months,  20  days. 


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SOME  OBSERVATIONS  ON  THE  OSSIFICATION  OF  THE 
BONES  OF  THE  HAND.* 


Previous  to  the  advent  of  the  X-Ray  all  timlings  as  to  the  time 
of  appearance  of  points  of  ossification  in  bones  and  other  features 
pertaining  to  the  process  of  ossification  were  dependent  upon  speci- 
mens obtained  from  the  dead  house.  Obviously  all  conclusions  were 
based  upon  the  examination  of  comparatively  few  subjects.  Many 
errors  that  have  been  perpetuated  in  standard  works  of  anatomy  are 
due  to  these  facts. 

In  a  Bulletin  of  State  University  of  Kentucky,  published  April, 
1908,  I  gave  the  results  of  the  examination  of  the  hands  of  five  hun- 
dred and  fifty-four  ( 554)  children  from  three  months  to  fourteen 
years  of  age.  Over  two  hundred  (200)  of  these  were  under  seven 
years  of  age. 

The  name,  age,  number  of  child,  order  of  ossification  and  size 
of  nucleus  in  M.  M.  was  given. 

A    careful    study    of    these    negatives    resulted    in    the    following 

observations  : 

First. — The   process   of   ossification   is   inaugurated   much   sooner 

than  hitherto  supposed. 

Second. — The  bones  of  the  female  ossify  in  advance  of  the  male. 
This  is  measured  at  first  by  days,  then  months,  then  years. 

Third. — The  chronological  order  in  which  the  bones  of  the  car- 
pus are  ossified  is  difi'erent  from  that  formerly  supposed. 

Pourth. — The  bones  of  the  first  child,  as  a  rule,  ossify  sooner  than 
those  of  subsecjuent  children. 

Pifth. — Regardless  of  the  variations  (normal)  the  ossification  is 
bilaterally  "^vmmetrical. 

Si.vth. — The  union  of  the  epiphyses  with  the  shaft  takes  place 
much  sooner  than  formerW  supposed. 

Sevcuth.—Y arintion  in  the  ossification  of  bones  is  a  heritable 
trait. 


*A   summary   of   this    article    was    read   before    the    Kentucky    State    Medical    Association, 
Louisville,    September    21-23,    1915. 


2.     E.  C— Female,  6  months. 


3.     E.  C— Female,  2  years,  5  months,  13  days. 


It  is  my  purpose  to  call  attention  to  each  of  these  observations, 
giving  some  of  the  proof,  in  the  way  of  illustrations  and  otherwise, 
that  I  believe  to  be  conclusive.  At  any  rate,  I  have  based  my  con- 
clusion on  the  proof  I  submit,  and  I  sincerely  hope  others  will  investi- 
gate this  subject  and  confirm  or  deny  my  conclusions.  I  see  no  reason 
why  there  should  be  a  decided  difference  between  the  hands  of  chil- 
dren in  the  State  of  Kentucky  and  those  of  other  States. 

First. — The  process  of  ossification  is  inaugurated  much  sooner 
than  hitherto  supposed. 

The  OS  magnum  is  the  first  bone  in  the  human  carpus  to  begin  the 
process  of  ossification.  In  the  hand  of  the  female,  the  first  point  will 
make  its  appearance  before  the  child  is  six  months  of  age.  In  excep- 
tional instances  ossification  may  begin  before  birth. 

In  all  of  the  hands  of  those  under  three  years  of  age,  the  size  of 
the  nucleus  would  indicate  the  average  appearance  of  the  magnum 
between  the  third  and  sixth  month,  and  that  of  the  unciform  a  few 
months  later.  The  cuneiform  will  make  its  appearance  between  the 
second  and  third  years.  The  fourth  bone  of  the  carpus  to  begin  ossifi- 
cation is  the  semilunar,  the  nucleus  of  which  will  appear  between  the 
third  and  fourth  year ;  while  that  of  the  scaphoid  -will  appear  when  the 
child  is  about  four  years  of  age,  or  early  in  the  fifth  year.  It  is  only  in 
rare  or  exceptional  instances  that  you  find  the  semilunar  or  scaphoid 
appearing  after  the  child  is  five  years  of  age. 

The  trapezoid  and  trapezium  will  make  their  appearance  betw^een 
the  fotn-th  and  fifth  year,  in  the  order  named.  The  last  bone,  or  pisi- 
form will  begin  ossification  between  the  ninth  and  tenth  year.  An  ex- 
amination of  the  table  will  show  that  in  only  six  instances  can  we  record 
the  absence  of  any  of  the  bones  that  should  be  present  when  the  child 
was  six  years  of  age  or  older. 

The  male  hand  is  slower  to  develop.  The  difference  is  measured 
at  first  by  days,  then  months,  then  years.  An  examination  of  this 
part  of  the  table  will  show  that  in  only  six  instances  can  we  find  the 
absence  of  any  of  the  seven  bones  of  the  carpus  that  should  be  present 
when  the  child  was  seven  years  of  age  or  older. 

The  first  eighteen  illustrations  given  are  fairly  representative  of 
the  average  hands  of  both  the  male  and  female. 

While  Figure  1  is  somewhat  in  advance  of  the  average  in  some 


4.     C.  G.  B. — Female,  i  year,  9  momhs,  24  days;  right. 


5.     C.  G.  B.— Female,  1  year,  9  months,  24  days,  left. 


respects,  in  others  it  is  no  farther  advanced  than  many  that  I  have 
observed.  Figure  2  is  the  hand  of  E.  C,  female,  age  6  months,  and 
Figure  3  is  the  same  hand  taken  at  the  age  of  2  years,  5  months  and  13 
days. 

Figure  4  and  5  are  the  right  and  left  hand  of  a  little  girl  1  year,  9 
months  and  26  days  of  age.  The  magnum  and  unciform  show  at  least 
one  year's  growth  and  a  large  number  of  epiphyses  of  the  metacorpal 
bones  and  phalanges  are  well  under  way  in  ossification. 

In  the  male  hand,  I  would  call  your  attention  to  Figure  12,  P.  M., 
male,  age  8  months  and  25  days,  and  Figure  13  is  the  same  hand  taken 
at  the  age  of  1  year,  6  months  and  6  days. 

My  investigation  along  this  line  brought  me  to  the  following  con- 
clusions in  regard  to' the  time  of  appearance  of  points  of  ossification  in 
the  bones  of  the  carpus  : 

between  the  third  and  sixth  month. 

between  the  fourth  and  tenth  month. 

between  the  fifth   and  tenth   month. 

between  the  sixth  and  twelfth  month. 

between  the  second  and  third  year. 

when  about  three  5fears  of  age. 

between  the  third  and  fourth  year. 

when  about  four  years  of  age. 

at   four  years  of  age,  or  early  in  fifth  year.. 

when  about  five  years  of  age. 

laetween    fourth    and    fifth    year     (preceding. 

trapezium), 
between     fifth     and     sixth     year     (preceding' 

trapezium ). 

lietween     fourth    and     fifth    year  (    preceded 

by  trapezoid), 
between    fifth    and    sixth   year    (preceded    by 

trapezoid) . 

between  the  ninth   and   tenth   year, 
between  the  twelfth    and   thirteenth   year. 


P 

Ph  <! 

< 


1  Fcniaic: 
I  Male: 
\  Female: 
\Male: 
1  Female: 
I  Male: 
i  Female: 
I  Male: 
\  Female: 
}  Male: 
f  Female: 

6.    Tr.\pEzoid  \  ji/„/^,. 


1.  Os    3.IAGNUM. 

2.  Unciform    . . 

3.  Cuneiform    . 

4.  Semilunar    . 

5.  Scaphoid    . . . 


7.    Trapezium 


f  Femal 
]  Male: 


\  Female. 
is.    Pisiform    I  Male: 


The  early  appearance  of  points  of  ossification  in  the  hand  is  also 
seen  in  those  of  the  epiphyses,  especially  those  of  the  phalanges  and 

metacarpal  bones.  .  ,  •    i        ^, 

The  Epiphyses  of  the  hand  are  all  cartilagmous  at  birth,      ihe 

diaphyses   are  Avell  advanced   in  ossification,   having  commenced  this 

process  "about  the  eighth  week  of  intra-uterine  life." 

The  first  point  of  ossification  to  appear,  of  the  epiphyses,  is  that 

of  the  lower  extremity  of  the  radius.    While  the  lower  extremity  of  the 


6.     M.   B. — Female,  2  years,  3  months,  10  days. 


-3JP 


7.     R.  A. — Female,  3  years,  10  months,  20  days. 


9 

radius  and  the  ulna  are  not  a  part  of  the  hand,  I  think  the  develop- 
ment of  these  epiphyses  should  be  considered  in  connection  with  the 
development  of  the  hand. 

In  the  hand  of  the  female  a  point  of  ossification  may  appear,  in 
the  epiphysis,  of  the  lower  extremity  of  the  radius,  as  early  as  two  or 
three  months  after  birth. 

This  we  see  in  the  hand  of  M.  B.  female,  age  one  year,  two  months 
and  twenty  days  (Fig.  1).  I  will  here  call  attention  to  all  of  the  illus- 
trations given,  the  youngest  of  which  indicates  an  early  ossification 
of  this  epiphysis.  In  every  hand  of  the  female  I  have  seen,  the  size 
of  the  nucleus  would  indicate  its  appearance  before  the  close  of  the  first 
year,  and  in  the  majority  about  the  eighth  month.  This  epiphysis  will 
unite  with  the  shaft  between  the  seventeenth  and  twentieth  years.  In 
the  majority  of  instances  it  will  unite  about  the  seventeenth  or  eight- 
eenth year.  It  appears  earlier  than  that  of  the  ulna,  but  is  later  in 
uniting  with  the  shaft. 

In  the  hand  of  the  male  the  epiphysis  of  the  lower  extremity  of  the 
radius  is  a  few  months  later  in  developing.  The  hand  of  P.  M.  male, 
age  ten  months  and  seven  days,  does  not  show  any  evidence  of  ossifica- 
tion of  this  epiphysis.  A  negative  of  the  same  hand  taken  a  few 
months  later,  /'.  e.,  at  the  age  of  one  year,  six  months,  and  six  days, 
(Fig  13.),  shows  an  oblong  nucleus,  five  m.  m.  in  width  and  two  m.  m. 
in  thickness,  indicating  its  appearance  soon  after  the  close  of  the  first 
year. 

This  is  the  fifth  child  of  his  parents  and  would  be  somewhat  slower 
in  developing.  In  every  hand  of  the  male,  that  I  have  examined,  a 
point  of  ossification  had  appeared  in  the  epiphysis  of  the  lower 
extremity  of  the  radius  before  the  child  was  two  years  of  age. 

I  think  in  a  majority  of  the  cases  this  epiphysis  will  begin  to  ossify 
in  the  hand  of  the  male  early  in  the  second  year,  that  is  about  the 
fifteenth  month.  This  epiphysis  will  unite  with  the  shaft  between  the 
eighteenth  and  twenty-first  year."  Like  the  hand  of  the  female,  it 
appears  before  that  of  the  ulna,  but  is  later  in  uniting  with  the  shaft. 

A  point  of  ossification  of  the  epiphysis  of  the  lower  extremity  of 
the  ulna,  of  the  hand  of  the  female,  may  appear  before  the  end  of  the 
fifth  year.  The  youngest  hand  I  have  seen  in  which  this  epiphysis  had 
appeared  was  at  the  age  of  four  years  and  six  months.    I  have  observed 


10 


8.     D.  P. — Female,  4  years,  4  months,  24  days. 


9.     C.  D. — Female,  4  years,  8  months,  18  days. 


11 

a  few  when  between  five  and  six  years  of  age.  At  least  ninety  per 
cent,  will  not  appear  until  the  child'  is  sir  years  of  age,  and  between  that 
and  seven.  Although  this  epiphysis  appears  four  or  five  years  after  that 
of  the  radius,  it  unites  with  the  shaft  before  it.  It  unites  with  the  shaft 
about  the  si.vtccnth  or  seventeenth  year,  sometimes  several  years  sooner. 
In  the  hand  of  the  male,  the  earliest  appearance  of  the  epiphysis 
of  the  lower  extremity  of  the  ulna,  was  at  the  age  of  five  years  and  four 
months.  Very  few  appeared  before  the  child  was  seven  years  of  age, 
and  the  majority  between  seven  and  eight  years  old.  In  the  hand  of  the 
male,  this  epiphysis  will  unite  with  the  shaft  from  the  seventeenth  to 
ihe.twentieth  year. 

In  regard  to  the  ossification  of  the  epiphysis  of  the  hand,  Cun- 
ningham^ says :  "The  secondary  centers  from  which  the  heads  of  the 
second,  third,  fourth,  and  fifth  metacarpals  and  the  base  of  the  first 
are  developed  appear  about  the  third  year  and  usually  completely  fuse 
with  the  shaft  about  the  age  of  twenty.  There  may  be  an  independent 
center  for  the  Styloid  process  of  the  third  metacarpal.  The  phalanges 
are  ossified  from  primary  and  secondary  centers.  From  the  former, 
which  appear  as  early  as  the  ninth  week  of  foetal  life,  the  shaft  and 
distal  extremities  are  developed  ;  whilst  the  latter,  which  begin  to  appear 
about  the  third  year,  form  the  proximal  epiphysis,  which  unite  with 
the  shaft  from  eighteen  to  twenty." 

I  quote  from  Morris-  as  follows :  "Each  of  the  metacarpal  bones 
and  phalanges  are  ossified  from  a  primary  center  for  the  greater  part 
of  the  bone  and  from  one  epiphyseal  center.  The  primary  nucleus 
appears  from  the  eighth  to  the  tenth  week  of  intra-uterine  life.  In 
the  inner  four  metacarpal  bones  the  epiphysis  is  distal,  whilst  in  the 
first  metacarpal  bone,  and  in  all  the  phalanges  it  is  proximal.  The 
epiphyseal  nuclei  appear  from  the  third  to  the  fifth  year  and  are  united 
to  their  respective  shafts  about  the  twentieth  year.  The  third  meta- 
carpal occasionally  has  an  additional  nucleus  for  the  prominent  Styloid 
process,  which  may  remain  distinct  and  form  a  Styloid  bone,  and  traces 
of  a  proximal  epiphysis  have  been  observed  in  the  second  metacarpal 
bone." 


1  Text  Book  of  Anatomy,  Cunningham,  pages  212,  213. 
-  Human   Anatomy,  page   152. 


12 


10.     L.  F. — Female,  5  years,  9  months,  28  days. 


11.     W.  S.— Male,  1  year,  9  months,  10  days. 


13 

HoLDEN^  gives  the  following:  "Each  metacarpal  bone  has  a  center 
of  ossification  for  the  shaft  and  proximal  end,  which  appears  near  the 
distal  end  about  the  eighth  week  of  foetal  life.  Each  also  has  an  epi- 
physis at  its  distal  end,  of  which  the  nucleus  appears  from  about 
the  third  to  the  fifth  year.  The  metacarpal  bone  of  the  thumb,  how- 
ever, has  its  epiphysis  at  the  proximal  end,  like  the  phalanges  of  the 
fingers.  All  unite  to  the  shaft  about  the  nineteenth  year.  Each 
phalanx  has  two  centers  of  ossification :  one  for  the  shaft  and  distal 
end,  appearing  about  the  eighth  week ;  the  other  for  the  proximal  end, 
appearing  from  the  third  to  tlie  fifth  year,  and  remaining  an  epiphysis 
till  about  the  twentieth  year." 

Gray*  says :  "The  metacarpal  bones  are  each  developed  by  two 
centers,  one  for  the  shaft  and  one  for  the  distal  extremity,  for  the 
four  inner  metacarpal  bones,  one  for  the  shaft  and  one  for  the  base,  for 
the  metacarpal  bone  of  the  thumb,  which  in  this  respect  resembles  the 
phalanges.  About  the  third  year  the  digital  extremities  of  the  four 
inner  metacarpal  bones  and  the  base  of  the  first  metacarpal  begins  to 
ossify  and  they  unite  about  the  twentieth  year. 

"The  phalanges  are  each  developed  by  two  centers ;  one  for  the 
shaft  and  one  for  the  base.  Ossification  of  the  base  commences  in  the 
first  row  between  the  third  and  fourth  years,  and  a  year  later  in  those 
of  the  second  and  third  row.  The  two  centers  become  united  in  each 
row,  between  the  eighteenth  and  twentieth  years." 

Poland-''  dififers  but  little  from  the  others  quoted,  he  says :  "The 
epiphysis  of  the  metacarpal  bone  of  the  thumb  is  developed  like  one  of 
the  phalanges,  the  epiphysis  being  situated  at  its  proxiiral  end.  In  the 
four  inner  or  true  metacarpals  the  epiphysis  is  placed  at  the  lower 
extremity.  Both  morphologically  and  developmentally  this  bone  should 
be  regarded  as  a  phalanx.  The  epiphyses  hitherto  cartilaginous  in  all 
the  metacarpal  bones  begin  to  ossify  about  the  third  and  unite  with 
the  shaft  about  the  nineteenth  year.  Ossification  takes  place  succes- 
sively from  the  first  phalanges  to  the  second,  and  lastly  in  the  third, 
in  the  first  row  from  the  third  to  the  fourth  year  and  on  the  second 
and  third  row  from  the  fourth  to  the  fifth  year.     The  epiphysis  of  the 


3  Human  Osteology,  Holden,  pages  355-338. 

4  Gray's  Anatomy,  pages  205,  206. 

5  Skiagraphic   Atlas,   Poland,   pages,   5,  6. 


14 


;r- 

■f' 

*... 

^ 

1 

12.     P.  M.— Male,  8  months,  21  days. 


13.     P.  M.  -Male,  1  year,  6  months,  6  days. 


15 

terminal  phalanx  of  the  little  finger  is  frequently  absent,  the  epiphyses 
unite  to  their  respective  shafts  alx)ut  the  nineteenth  year." 

My  observations  differ  very  materially  from  the  above,  quoted 
from  the  latest  editions  of  these  standard  works. 

There  is  no  distinction  made  b_y  any  of  these  authors  between  the 
hand  of  the  male  and  that  of  the  female,  and  yet  there  can  be  no  ques- 
tion that  the  hand  of  the  female  develops  much  sooner  than  that  of  the 
male.  As  I  have  said  before,  this  is  first  measured  by  days,  then 
months,  then  years.  The  fully  developed  hand  of  the  female  being  at 
least  two  years  in  advance  of  that  of  the  male.  Whilst  the  individual 
skiagrams  show  this  difference  in  the  development  of  the  hand  of  the 
female  in  advance  of  that  of  the  male,  the  contrast  is  more  distinctly 
and  picturesquely  shown  in  twins  of  the  same  sex  and  those  of  diff'erent 
sexes. 

The  second  epiphysis  to  appear  in  the  hand  of  the  female  is  that 
of  the  proximal  extremity,  of  the  first  phalanx  of  the  middle  finger, 
followed  by  the  ring,  index,  and  little  fingers,  then  the  thumb.  The  first 
named  mav  appear  as  early  as  the  sixth  month,  as  seen  in  the  hand 
of  M.  B.  female,  age  one  year,  two  months,  and  twenty  days  (Fig.  1.). 
The  size  of  this  nucleus  would  indicate  eight  to  ten  months'  growth. 
Another  exposure  of  this  hand  was  made  at  the  age  of  two  years,  three 
months,  and  ten  days  (Fig.  6.),  which  shows  two  new  centers,  that  of 
the  first  phalanx  of  the  thumb  and  that  of  the  second  phalanx  of  the 
little  finger.  These  I  have  noticed  in  a  number  of  instances  develop 
synchronously.  This  may  be  a  coincidence.  I  shall  endeavor  to  deter- 
mine, sometime  in  the  future,  if  they  bear  an  anatomical  relationship. 
Another  exposure  of  this  hand  was  made  at  the  age  of  three  years,  two 
months,  and  nine  days,  in  which  we  have  all  the  epiphyses.  The  last  to 
appear  is  that  of  the  ungual  phalanx  of  the  little  finger.  All  have 
appeared  before  the  child  was  three  years  of  age. 

This  is  not  an  exceptional  hand,  as  will  be  seen  when  compared 
with  Figs.  4  and  5,  C.  G.  B.,  female,  age  one  year,  nine  months,  and 
twenty-four  days.  In  this  hand  all  the  epiphyses  have  appeared.  The 
size  of  the  epiphyses  of  the  first  row  of  phalanges  and  those  of  the 
metacarpal  bones,  and  the  form  they  are  assuming,  would  indicate 
something  of  the  time  of  their  appearance.  The  first  named,  appearing 
as  early  as  the  sixth  or  eighth  month,  and  all,  with  the  exception  of 


16 


14.     T.  K.— Male,  3  years,  9  months,  17  days. 


% 


>v     n,. 


U^ 


15.     C.  G.  — Maie,  4  years,  4  months,  3  days. 


17 

those  of  the  metacarpal  bone  of  the  thumb,  have  made  their  appearance 
before  the  close  of  the  fifteenth  month.  That  of  the  second  metacarpal 
bone  appeared  synchronous  with  or  soon  after  that  of  the  first  phalanx 
of  the  middle  finger,  i.  e.,  between  the  sixth  and  eighth  month,  followed 
by  the  third,  fourth,  fifth,  and  lastly  the  first  or  metacarpal  bone  of 
the  thumb,  in  which  we  see  a  minute  point  of  ossification,  appearing 
in  the  twenty-second  month  or  late  in  the  second  year.  The  epiphyses 
of  the  second  row  of  phalanges,  beginning  with  the  middle  finger,  began 
to  ossify  late  in  the  first  year.  This  was  followed  by  the  ring,  the 
index,  and  little  finger.  All  must  have  appeared  before  the  close  of  the 
fifteenth  month.  The  ungual  epiphyses  are  all  present.  That  of  the 
thumb  appearing  first,  having  commenced  to  ossify  as  soon  as  the  tenth 
month.  The  thumb  is  followed  by  the  middle  finger,  then  the  ring 
finger,  the  index  finger  and  lastly  by  the  little  finger,  in  which  we  see 
a  small  point  of  ossification,  making  its  appearance  in  the  twenty-second 
month.  In  this  hand  we  have  an  instance  in  which  all  of  the  epiphyses 
have  appeared  before  the  childi  was  tzvo  years  of  age.  In  some  respects 
this  hand  is  far  in  advance  of  the  one  just  described,  and  in  some 
respects  it  presents  a  slower  development.  Note  the  cuneiform  in  the 
former  and  its  absence  in  the  latter. 

We  will  next  consider  the  hand  of  D.  D.,  female,  age  two  years, 
two  months,  and  twenty-three  days,  fourth  child  of  parents.  This 
child  is  but  a  few  months  over  two  years  of  age  and  all  of  the  epiphyses 
have  appeared.  That  of  the  ungual  phalanx  of  the  little  finger  is  a 
minute  point,  but  is  distinct  in  both  hands.  All  of  the  other  epiphyses 
are  well  advanced  in  ossification.  In  some  respects  this  hand  is  in 
advance  of  either  of  the  two  previously  described.  Note  the  size 
of  the  nuclei  of  the  metacarpal  epiphyses  and  those  of  the  magnum, 
unciform  and  cuneiform  bones.  The  sister  of  this  child  (Fig.  9.), 
C.  D.,  age  four  years,  eight  months,  and  eighteen  days,  is  given  for  the 
sake  of  comparison.  The  advanced  state  of  ossification  of  all  of  the 
epiphyses  in  this  hand  shows  that  this  process  had  commenced  fully 
as  soon  as  that  of  the  sister  two  years  and  six  months  younger.  All 
of  these  epiphyses  had  commenced  to  ossify  before  the  child  was  two 
and  one-half  years  of  age.  I  will  also  call  attention  to  the  chronological 
development  of  the  bones  of  the  carpus,  in  which  we  find  the  trapezoid 
preceding  the  scaphoid.     The  younger  sister  has  not  reached  the  age 


18 


16.     J.  S.  Male,  5  years,  2  months,  8  days. 


17.     J.  B. — Male,  6  years,  4  months. 


19 

when  these  should  appear.    However,  I  expect  to  find'  her  liand  develop- 
ing in  the  same  order. 

The  next  illustration  is  that  of  E.  C,  age  two  years,  five  months, 
and  thirteen  days,  second  child  of  parents  (Fig.  3.).  All  of  the  epi- 
physes of  this  hand  have  commenced  ossification  except  that  of  the 
first  phalanx  of  the  thumb,  the  second  phalanx  of  the  little  finger  (vou 
will  see  the  similarity  concerning  these  two),  and  the  ungual  phalanges 
of  the  index  and  little  fingers.  The  ossificatoin  of  the  epiphyses  of  this 
hand  is  similar  to  those  described.  All  of  the  nuclei  will  have  appeared 
before  the  child  is  three  years  of  age. 

After  a  careful  investigation  of  these  and  a  number  of  other  hands 
of  females  three  years  of  age  and  younger,  I  have  thought  the  average 
hand  of  the  female  would  develop  in  the  following  order :  The  epi- 
physis of  the  first  phalanx  of  the  middle  finger  will  show  the  first  point 
of  ossification  before  the  close  of  the  first  year.  This  will  be  followed 
by  the  ring  and  index,  then  the  little  finger.  All  will  have  appeared  by 
the  close  of  the  fifteenth  month.  Synchronous  with,  or  immediately 
after  this,  the  epiphyses  of  the  distal  extremities  of  the  metcarpal  bones 
will  appear  in  the  following  order:  The  first  to  appear  is  that  of  the 
index  finger,  then  the  middle,  then  the  ring,  then  the  little  finger,  and 
lastly  the  thumb.  That  of  the  index  finger  will  make  its  appearance 
before  the  close  of  the  first  year.  All  will  have  appeared  by  the 
fifteenth  month,  except  that  of  the  thumb,  which  usually  does  not  com- 
mence to  ossify  until  the  child  is  over  tzvo  years  of  age.  The  epiphyses 
of  the  second  row  of  phalanges  appear  in  the  same  order  as  those  of  the 
first  row,  i.  e.,  middle,  ring,  index,  little  fingers  successively.  The  first 
named  appears  about  the  close  of  the  first  year.  All  are  usually  present 
before  the  child  is  tivo  years  of  age.  The  epiphysis  of  the  first  phalanx 
of  the  thumb  appears  synchronous  with  that  of  the  second  phalanx  of 
the  little  finger  before  the  close  of  the  second  year. 

The  last  row  of  phalanges  or  ungual  phalanges  appear  in  the 
following  order:  The  first  point  to  appear  is  in  the  thumb,  followed  by 
the  middle,  ring,  index  and  little  fingers.  The  first  named  will  appear 
early  in  the  second  year  or  between  the  fifteenth  and  tzventieth  month. 
That  of  the  middle  finger  will  appear  soon  after  the  thumb.  All  will 
have  made  their  appearance  before  the  close  of  the  third  year  or  by  the 
time  the  child  is  three  years  of  age. 


20 


18.     E.  W.— Female,  3  years,  6  months,  21  days. 


19.     H.  W.— Male,  5  years,  2  months,  21  days. 


21 

In  illustrating  the  ossification  of  the  epiphyses  in  the  hand  of  the 
male,  the  youngest  hand  I  have  showing  points  of  ossification  in  these 
epiphyses  is  that  of  P.  M.,  age  one  year,  six  months,  and  six  days 
(Fig.  13).  This  is  a  fifth  child  of  parents  and  is  somewhat  slower 
in  development  than  the  first  or  second  children.  As  in  the  hand  of  the 
female,  the  first  epiphysis  to  appear  is  that  of  the  lower  extremity  of 
the  radius.  The  nucleus  is  5x2  m.  m.  This  evidently  appeared  soon 
after  the  close  of  the  first  year.  In  this  hand  the  second  epiphyses  to 
begin  the  process  of  ossification  is  a  proximal  epiphysis  to  the  second 
metacarpal  bone.  I  would  judge  this  made  its  appearance  at  the  close 
of  the  first  3-ear. 

I  have  observed  this  extra  epiphysis  in  the  hands  of  but  six  families 
out  of  over  two  hundred  families.  It  is  therefore,  not  of  common 
occurrence,  but  is  comparaitvely  rare.  It  unites  very  soon  with  the 
shaft,  sometimes  before  the  fourth  year,  usually  by  the  sixth  or 
seventh  year,  although  the  union  may  be  delayed  until  the  fourteenth 
year.  As  it  sometimes  unites  with  the  shaft  so  early,  it  is  possible  I 
may  have  a  number  of  hands  in  which  the  epiphyseal  line  is  completely 
obliterated,  and  it  may  occur  with  more  frequency  than  my  observa- 
tions would  indicate. 

In  this  hand  the  next  epiphysis  to  appear  was  that  of  the  middle 
finger  of  the  first  row  of  phalanges,  followed  by  the  ring  and  index 
fingers.  That  of  the  little  finger  has  not  appeared.  I  would  judge, 
these  made  their  appearance  about  the  fifteenth  month.  There  is  a 
minute  point  of  ossification  in  the  ungual  phalanx  of  the  thumb  appear- 
ing in  the  eighteenth  month. 

Another  exposure,  of  this  hand,  was  made  at  the  age  of  one  3'ear, 
eleven  months,  and  six  days,  that  is,  five  months  following  the  last. 
All  the  epiphyses  present  at  the  previous  sitting  have  increased  in  size. 
You  will  see  the  nucleus  of  the  proximal  epiphysis  of  the  second  meta- 
carpal has  increased  in  size  and  is  rapidly  uniting  with  the  shaft.  The 
new  points  of  ossification  to  be  seen  are,  the  distal  epiphyses  of  the 
second  and  third  metacarpals,  and  those  of  the  second  rozv  of  phalanges, 
beginning  with  the  middle  finger,  then  the  ring  finger,  all  appearing 
before  the  close  of  the  second  year. 

In  this  hand  (Fig.  13.)  we  find  the  first  appearance  of  a  scale- 


22 


20.     Erna  K.— Female,  5  years,  1  month,  12  days. 


-*^t'* 


21.     Ermie  K.— Male,  5  years,  1  month,  12  days. 


23 

I 

like  epiphysis,  sometimes  present  at  the  distal  extremity  of  the  first 

metacarpal. 

Cunningham®  says  of  this  epiphysis :  "There  is  usually  a  scale- 
like epiphysis  on  the  head  of  the  first  metacarpal,  which  makes  its 
appearance  about  eight  or  ten,  and  rapidly  unites  with  the  head." 

Morris"  says :  "In  many  cases  the  first  metacarpal  has  two  epi- 
physes, one  for  the  base  in  the  third  and  an  additional  one  for  the 
head  in  the  seventh  year,  but  the  latter  is  never  so  large  as  in  the  other 
metacarpal  bones." 

Poland®  says :  "Traces  of  a  distal  epiphysis  in  the  metacarpal 
bone  of  the  thumb  are  usually  to  be  seen,  and  in  some  instances  a  dis- 
tinct epiphysis  (as  in  the  Seal  and  some  other  animals)  is  visible  at  the 
age  of  seven  or  eight  years." 

HoLDEN^  says :  "Very  often  there  is  a  distal  epiphysis  appearing 
in  the  metacarpal  of  the  thumb  about  the  eighth  year  and  an  epiphysis 
at  the  proximal  end  of  the  second  metacarpal  about  the  same  time." 

My  observations  are  quite  different  from  those  quoted.  I  have 
found  this  epiphysis  present  in  about  six  per  cent,  of  the  cases.  It  is 
possible  it  occurs  with  greater  frequency,  as  it  unites  with  the  head  of 
the  bone  very  rapdily  and  could  be  overlooked,  and  the  epiphyseal  line 
is  soon  obliterated.  I  have  been  fortunate  in  having  the  opportunity 
to  present  the  first  appearance  of  this  epiphysis  in  one  hand  at  least 
(Fig.  13.).  You  will  see  a  small  elevation  on  the  distal  extremity  of 
the  metacarpal  bone  of  the  thumb ;  this  I  am  sure  is  a  separate  point 
of  ossification.  In  the  exposure  of  this  hand,  made  six  months  later, 
this  epiphysis  has  flattened  and  increased  in  size.  The  epiphyseal  line 
is  not  distinct. 

The  shape  of  this  epiphysis  is  quite  different  from  others  in  the 
hand.  The  head  of  the  metacarpal  bone  is  slightly  hollowed.  The 
epiphysis  becomes,  as  it  is  increased  in  size,  convex  on  the  upper 
surface  and  concave  beneath,  thicker  in  the  center  and  very  thin  at  the 
periphery.  It  thus  fills  the  cavity  in  the  upper  extremity  of  the  shaft 
and  forms  the  rounded  head  of  the  bone. 


6  Text  Book  of  Anatomy,  Cunningham,  page  212. 
'■  Human   Anatomy,    Morris,   page   152. 
s  Skiagraphic  Atlas,  Poland,  page  58. 
9  Human   Osteology,  Holden,  page  335. 


24 


22.     U.  W.— Female,  6  years,  2  months,  15  days. 


23.     H.  C.  T.— Male,  6  years,  4  months,  25  days. 


25 

This  cannot  be  seen  in  the  print :  we  can  ahvays  see  a  great  deal 
of  detail  in  the  negative  that  is  lost  in  the  print,  and  there  is  still  greater 
loss  in  the  half-tone.  However,  in  the  older  hands  we  have  an  oppor- 
tunity of  a  distinct  view  of  this  epiphysis.  The  older  brother,  G.  M., 
age  six  years  and  one  month  (Fig.  65.),  gives  a  splendid  example  of  this 
epiphysis.  The  epiphyseal  line  is  distinct,  whilst  in  the  hand  of  the 
sister,  age  eight  years  and  one  month,  the  line  is  almost  obliterated, 
and  in  the  hand  of  the  still  older  sister,  age  ten  years,  the  line  is  com- 
pletely obliterated  and  it  would  be  impossible  to  tell  there  had  ever 
been  an  epiphysis  at  this  point. 

The  oldest  hand  in  which  I  can  positively  trace  this  epiphysis  is 
about  eight  years  of  age,  that  is  in  which  the  epiphyseal  line  is  not 
obliterated.  The  size  of  the  nuclei  in  all  of  my  negatives  would 
indicate  its  appearance  before  the  child  was  four  years  of  age,  and 
sometimes  much  sooner,  as  in  the  instance  I  have  given  in  which  it 
made  its  appearance  about  the  seventeenth  month. 

In  place  of  making  its  appearance  at  the  eighth  year,  my  observa- 
tions indicate  its  disappearance  at  that  age. 

I  have  examined  over  two  hundred  negatives  of  hands  four  years 
old  arid  older  without  the  slightest  evidence  of  an  epiphysis  appearing 
at  this  point  after  the  child  has  become  four  years  of  age.  T  am 
sure  it  never  appears  as  late  as  the  eighth  year. 

The  hand  of  W.  S.,  male,  age  one  year,  nine  months,  and  ten  days 
(Fig.  11.),  is  developing  in  the  same  order  as  the  one  described,  but 
shows  more  points  of  ossification  than  the  other  would  have  shown  at 
the  same  age.  This  is  the  first  child  of  parents.  In  this  hand  the 
riucleus  of  the  epiphysis  of  the  lower  extremity  of  the  radius  is  6x3 
m.  m.  This  began  to  ossify  before  the  close  of  the  first  year.  The 
second  point  to  appear  is  that  of  the  middle  finger,  first  row  of 
the  phalanges,  followed  by  the  ring  and  index  fingers,  and  there  is  a 
minute  point  starting  in  the  little  finger.  The  epiphysis  of  the  second 
metacarpal  commenced  ossification  simultaneous  with  or  a  short  time 
before  that  of  the. first  phalanx  of  the  middle  finger.  This  is  followed 
by  the  third  and  fourth  metacarpals,  and  there  is  a  good  sized  point 
in  the  ungual  phalanx  of  the  thumb.  The  first  of  these  must  have  com- 
menced the  process  of  ossification  by  the  fifteenth  month.     There  is 


26 


I 


i 


25.     1.  B.— Female,  6  years. 


27 

every  reason  to  believe  that  the  other  epiphyses  will  appear  rapidly 
in  this  hand.  You  will  note  a  good  sized  nucleus  of  the  cuneiform 
which  has  appeared  after  the  close  of  the  first  year. 

After  a  careful  examination  of  a  large  number  of  other  hands, 
both  male  and  female,  four  years  of  age  and  younger,  I  am  enabled 
to  at  least  approximate  the  chronological  development  of  the  epiphyses 
as  given  in  the  following  table : 


28 


26.     E.  C  — Female,  5  years,  9  months,  14  days. 


27.     I.  M.  F.— Female,  5  years,  1  month,  12  days. 


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30 


28.     V.  C. — Female,  5  years,  10  months,  14  days. 


29.     A.  P.— Female,  5  years,  6  months,  1  day. 


Q1 


The  second  observation.  The  bones  of  the  female  ossify  in 
advance  of  the  male.  This  is  measured  at  first  by  days,  then  months, 
then  years. 

A\'hile  this  fact  may  be  said  to  have  been  obvious,  the  progressive 
differences  have  never  been  so  graphically  shown.  This  may  be  illus- 
trated with  the  hands  of  twins  of  the  same  sex,  in  which  there  is  a 
development  of  the  same  degree,  while  in  twins  of  different  sex,  the 
hand  of  the  female  is  much  in  advance  of  that  of  the  male,  as  shown 
by  Fig.  20  and  21.  I  have  a  number  of  negatives  of  brothers  and 
sister's  hands  showing  the  marked  difference  in  development.  Fully 
as  much  as  that  seen  in  Figs.  18  and  19. 

I  here  append  an  extract  from  an  article  on  "The  Development  of 
the  Bones  in  Early  Life,"  by  Thomas  Morgan  Rotch,  M.  D.,  Professor 
of  Pediatrics,  Harvard  University. 

"Through  the  courtesy  of  Professor  Pryor,  I  am  making  use  of  his 
table  of  the  Anatomic  Index  which  shows  the  marked  difference  in 
time  of  the  anatomic  development  of  girls  and  of  boys. 

Table    \'I. — Comparison    of    the    Development    of    the    Wrist    Index    According 

to  Sex   (Pryor). 


Sex. 

Female 
Male 

Female 
Male 

Female 
Male 

Female 
Male 

Female 
Male 


Age. 
Years. 


1/3 
9 


]\Tagnnm.  nnciform. 


A. 


B. 


2V2 

3/3 
414 

414 
5^ 


^ 


}ilagnnm,  unciform,  radius   (lower  epiphysis). 

C. 
Magnum,  unciform,  radius,  cuneiform. 

D. 

Magnum,  unciform,  radium,  cuneiform,  semilunar. 

E. 
Magnum,  unciform,  radius,  cuneiform,  semilunar,  and  one  of 


(  the   following:     Scaphoid,  trapezoid,  trapezium. 


Female      434      ]      Magnum,  unciform,  radius,  cuneiform,  semilunar,  and  izvo  of 
Male  534      I  the  following:     Scaphoid,  trapezoid .  trapezium. 

G. 
Female      5^4      )      Magnum,   unciform,    radius,   cuneiform,    semilunar,    scaphoid, 
Male  634      i  trapezoid,   trapezium. 

H. 
Female      6^4      I      Magnum,   unciform,    radius,    cuneiform,    semilunar,    scaphoid, 
INIale  7^4      j  trai^ezo.d,   traieziun:,   rlra    (lower   epiphysis). 


32 


30.     M.  R.— Female,  5  years,  1  month,  9  days. 


31.     J.  P. — Male,  6  years,  3  months. 


33 

TA.BLE  VI— Continued. 
I. 

eina  e        /2       (      Same  as  H,  but  more  advanced. 
Male  9  ) 

J. 

ema  e        /2      (       S^me  as  I,  but  more  advanced. 
Alale        10  ) 

K. 

Female    10^      |      Magnum,   unciform,    radius,   cuneiform,    semilunar,    scaphoid, 
rvlale        12^      f  trapezoid,  trapezium,  ulna,  pisiform. 

The  following  illustrations  given  to  me  by  Dr.  Pryor  lead  me  to 
believe  that  somewhat  different  rules  should  be  adopted  for  the  grad- 
ing of  girls  than  for  that  of  boys.  In  fact,  there  is  such  a  manifest 
dift'erence  in  the  chronologic,  physiologic,  and  anatomic  ages  of  young 
human  beings  in  the  formative  stages  of  life  according  to  sex,  that  we 
should  endeavor  to  practically  make  use  of  this  knowledge  in  our 
efforts  to  safeguard  their  lives." 

Third. — The  chronological  order  in  which  the  bones  of  the  carpus 
are  ossified  is  diff'erent  from  that  formerly  supposed. 

In  the  following  chronological  table  I  have  given  by  numbers  the 
order  in  which  the  bones  of  the  carpus  have  ossified  as  indicated  by  the 
size  of  the  nucleus. 

In  this  table  I  have  included  only  those  in  which  the  chronology 
was  distinct.  There  is,  of  course,  opportunity  for  error  in  this.  There 
may  possibly  be  a  much  larger  proportion  of  cases  in  which  the  unci- 
form has  preceded  the  magnum  than  is  indicated  by  their  relative 
size.  There  could  not  be  great  error  in  this,  at  least  not  enough 
to  materially  change  the  result  or  influence  the  conclusions.  I  have 
not  tried  to  obtain  a  large  number  of  subjects  under  one  year  of  age 
for  the  reason  that  the  results  w^ere  uniform  in  such  a  large  majority 
that  it  seemed  unnecessary.  The  magnum  is  a  larger  bone  than  the 
unciform  and  the  nucleus  of  the  former  will  soon  exceed  m  size  the 
latter.  This  would  indicate  that  the  rate  of  deposit  of  lime  salts  in 
the  larger  bone  would  exceed  that  of  the  smaller  bone.  However,  the 
larger  size  of  the  nucleus  does  not  always  indicate  priority  of 
appearance. 

The  deposit  of  lime  salts  in  anticipation  of  the  shape  of  the  com- 
pleted bone  is  fairly  uniform  in  all  instances,  and  is  peculiar  to  each 
bone. 


34 


32.     C.  B  — Female,  5  years,  9  month?,  17  days,  right. 


33.     C.  B. — Female,  5  years,  9  months.  17  days  lefi.. 


35 

In  all  of  the  bones  of  the  carpus  the  first  appearance  is  that  of  a 
pin  point.  This  will  become  round  and  then  elongate,  and  as  it  enlarges 
the  shadow  will  be  characteristic  of  each  bone.  Thus  that  of  the 
magnum  will  be  longer  in  the  vertical  diameter  and  is  usually  con- 
stricted in  the  middle.  The  unciform  always  assumes  a  trianglar  shape, 
with  the  apex  toward  the  centre  and  directed  obliquely  downward  and 
inward.  The  cuneiform  becomes  oval  with  the  long  diameter  obliquely 
downward  and  inward. 

The  semilunar  remains  round  on  the  surface,  but  often  becomes 
pyramidal.  The  scaphoid  rapidly  grows  in  the  long  diameter  of  the 
bone  and  soon  distinctly  anticipates  the  boat  shape.  The  trapezoid  and 
trapezium  remain  round  until  they  are  quite  large.  Although  the 
palmar  surface  of  the  bone  is  in  contact  with  the  plate,  the  shadow 
cast  is  largely  determined  by  the  dorsal  surface  w^hich  is  interposed 
between  the  tube  and  the  plate,  thus  obstructing  the  rays.  When 
the  negative  is  compared  with  the  bone,  the  resemblance  to  the  dorsal 
surface  is  distinct. 


36 


34.     S.  G. — Female,  5  years;  right. 


35.     S.  G. — Female,  5  years,  left. 


37 


g 

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Name. 

bo 

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Size 
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in  M  M. 

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9. 

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C.  S.  . . . 

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2 

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4 

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17. 

R.  A.  . . . 

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3-10-20 

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3-11-22 

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2 

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4 

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0 

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20. 

B.  D.  ... 

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0-  0 

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2 

3 

4 

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0-  0 

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2 

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6 

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0 

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3-Tm.  1. 

22. 

C.  F.  . . . 

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4- 

1-  7 

1st        1 

2 

3 

4 

5 

7 

6 

0 

S.  7-Sc.  6-Td. 
4  Tm.  5 

23. 

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4- 

1-23 

4  th       1 

9 

3 

0 

0 

0 

0 

0 

C.  5 

24. 

M.  B.  ... 

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4- 

2-18 

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9 

3 

4 

0 

0 

0 

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25. 

D.  P.  . . . 

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4- 

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3 

4 

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5 

7 

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26. 

T.  S 

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4- 

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2 

3 

4 

0 

0 

0 

0 

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27. 

:>,i.  L.  K. 

.F. 

4- 

7-  9 

1st       2 

1 

3 

4 

5 

0 

0 

0 

S.  4-Sc.  .8 

28. 

B.  D.  . . . 

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4- 

8-lS 

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9 

3 

4 

6 

5 

0 

0 

S.  5-Sc.  4-  Td. 
3-5 

29. 

J.  L.  W. 

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4- 

9-  5 

2 

3 

4 

5 

0 

0 

0 

S.  5-Sc.  1.2 

30. 

E.  T 

.F. 

4- 

9-12 

2 

3 

4 

5 

6 

7 

0 

S.  6 

31. 

V.  A.  ... 

.F. 

4-10-15 

1st       1 

2 

3 

4 

5 

0 

0 

0 

Sc.  .8 

32. 

E.  B.  . . . 

.F. 

4-10-22 

1st       1 

2 

3 

4 

7 

6 

5 

0 

S.  8-Sc.  5-Td. 

4-Tm.  7 

33. 

R.  H.  . . 

F. 

4-11-  7 

3rd       1 

2 

3 

4 

7 

5 

6 

0 

S.  5-Sc.  1-Td: 

3.2-Tm.  2 

34. 

S.  G.  ... 

.F. 

5- 

0-  1 

2nd      I 

2 

3 

7 

5 

6 

4 

0 

S.  2-Sc.  3-Td. 
2.5-Tm.  5 

35. 

M.  R.  ... 

.F. 

5- 

1-  9 

1st       1 

1 

3 

7 

6 

4 

5 

0 

S.    3-Sc.    4.8- 
Td.  5.2-Tra.  1 

38 


36.     L.  F. — Male,  5  years,  4  months,  9  days;  right. 


37.     L.  F.— Male,  5  years,  4  months,  9  days;  left. 


^ 

u.' 

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5 

n! 

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Size 

Name. 

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Nucleus 

y. 

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p 

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in  M  M. 

o 

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cr. 

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J.  M.  F.. 

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5-  1-12 

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2 

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0 

4 

0 

6 

5 

0 

S.  5-Td.  4-Tm. 

5 

S.  6-Td.  3.2- 

Zl. 

R.  E.  . . . 

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5-  1-12 

3rd       1 

2 

3 

4 

0 

5 

6 

0 

Tm.  3 

38. 

H.  K.  . . . 

.F. 

5-  1-12 

1st        ] 

2. 

3 

4 

7 

6 

5 

0 

S.  6-Sc.  2-Td. 
3-Tm.  4 

40. 

I.  R 

.F. 

5-  1-16 

4th       ] 

2 

3 

4 

0 

5 

0 

0 

S.  4-Td.  .2 

41. 

A.  M.  W 

.F. 

5-  1-21 

4th 

2 

3 

4 

0 

0 

0 

0 

S.  2.5 

42. 

L.  F.   . . . 

.F. 

5-  3-13 

1st 

1 

4 

3 

6 

5 

0 

0 

C.    5-S.    8-Sc. 
1-Td.  2 

43. 

T.  C.  . . . 

p 

5-  3-22 

3rd  * 

2 

3 

4 

0 

0 

0 

0 

S.  5 

44. 

H.  S.  . . . 

'.R 

5-  3-27 

2nd 

2 

3 

0 

0 

0 

0 

0 

C.  3 

45. 

C.  s.  ... 

.F. 

5-  4-  7 

1st 

2 

3 

4 

0 

5 

6 

0 

S.   5-Td.   2- 
Tm.  .2 

46. 

C.  B.  ... 

.F. 

5-  9-17 

3rd 

2 

3 

0 

5 

4 

0 

0 

Sc.  5-Td.  6 

47. 

E,  J.   . . . 

.F. 

5-  5-12 

1st 

2 

3 

7 

5 

6 

4 

0 

Sc.  4.6-Td.  4- 
Tm.  5 

48. 

A.  W.  . 

.F. 

5-  5-22 

3rd 

2 

3 

5 

4 

6 

0 

0 

S.  3-Sc.  4-Td, 

1 

S.  7-Sc.  3-Td. 

49. 

A.  P.  . . . 

.F. 

5-  6-  1 

4th 

7 

3 

4 

7 

6 

5 

0 

5  Tm.  6 

50. 

M.  P.    .. 

.F. 

5-  6-24 

4th 

I      2 

3 

0 

0 

0 

4 

0 

M.  3 

51. 

M.  E.   .. 

.F. 

5-  7-  0 

1st 

2 

3 

5 

6 

7 

4 

0 

S.  6-Sc.  8-Td. 
5  Tm.  8.2 

52. 

^[.  V.  . . 

.F. 

5-  7-  3 

1st 

2 

3 

.4 

6 

5 

7 

0 

Sc.  5-Td.  6- 
Tm.  4 

53. 

M.   S.    .. 

.F. 

5-  7-  8 

2nd 

2 

T 

4 

0 

5 

6 

0 

Td.  3-Tm.  2 

54. 

A.  L.  F. 

.F. 

5-  7-20 

10th 

2 

3 

4 

0 

0 

0 

0 

S.  5 

55. 

V.  B.  . . . 

.F. 

5-  7-24 

1st 

1 

3 

4 

6 

5 

7 

0 

Sc.  5-Td.  6- 
Tm.  3.5 

56. 

V.  Y.    .. 

-F. 

5-  7-29 

4th 

7 

3 

7 

5 

6 

4 

0 

S.  4-Sc.  6-Td. 
51-Tm.  9 

57. 

M.  R.   .. 

.F. 

5-  8-  5 

1st 

2 

3 

4 

6 

7 

5 

0 

Sc.  5-Td.  6- 
Tm.  7 

58. 

E.  C.  . . . 

.F. 

5-  9-14 

2nd 

2 

3 

4 

7 

5 

6 

0 

Sc.  2.5  Td.  5- 
Tm.  4 

'Q 

^  F.  . . . 

F 

5-  9-28 

1st 

9 

4 

3 

6 

5 

0 

0 

Sc.  6-Td.  5 

60. 

H.  S.   .. 

..F 

5-10-  9 

3rd 

-> 

3 

4 

5 

6 

7 

0 

Sc.  4.1-Td   4- 
Tm.  3 

61. 

R.  K.  ... 

.F. 

5-10-  9 

3rd 

2 

3 

6 

7 

4 

5 

0 

S.  3.5-Sc.  2.5- 
^d.  5-Tm.  4 

62. 

V.  C.  . . . 

.F. 

5-10-14 

2nd 

2 

3 

4 

7 

5 

6 

0 

Sc.  4-Td.  6- 
Tm.  5 

ez. 

H.  P.  R. 

.F. 

5-11-16 

1st        ] 

1 

3 

4 

7 

5 

6 

0 

Sc.  .3-Td.  3- 
Tm.  2 

64. 

A.  W.   . . 

.F. 

5-11-28 

3rd 

2 

3 

0 

0 

0 

0 

0 

65. 

I.  B 

.F. 

6-  0-  0 

1st        ] 

2 

3 

5 

0 

4 

0 

0 

e^e^. 

M.  B.    .. 

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6-  0-  2 

...        ] 

1 

3 

0 

0 

0 

0 

0 

67. 

B.  F.  . . . 

.F. 

6-  0-  3 

1st       1 

2 

3 

4 

5 

6 

7 

0 

68. 

H.  T.  ... 

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6-  0-  4 

3rd       ] 

9 

3 

4 

5 

6 

7 

0 

69. 

H.  R.    .. 

-F. 

6-  0-  7 

3rd       1 

2 

3 

4 

5 

6 

7 

0 

1 

40 


38.     S.  J.— Female,  7  years,  6  months,  4  days;  right. 


39.     S.  J.— Female,  7  years,  6  months,  4  days;  left. 


_.       d 

E 

^ 

: 

;r 

E 

='            Size 

Xame. 

=      ^ 

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E 

H 

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^ 

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70.  A.  B.  C...F. 

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2      3 

4 

/ 

5 

6 

0 

71.  S.  F F. 

6-  0-16 

1st       1 

-> 

1 

4 

^ 

6 

7 

0 

12.  M.  L.  K..F. 

6-  0-20 

In       2 

1       3 

4 

^ 

6 

7 

0 

li.  M.  P F. 

6-  0-23 

2r.d      1 

■> 

1 

4 

5 

/ 

6 

0 

74.  I.  S F. 

6-  1-  0 

2nd      1 

7 

! 

4 

5 

7 

6 

0 

75.  M.  C.  R..F. 

6-  1-  4 

4  th       1 

1 

^ 

4 

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5 

6 

0 

76.  X.  \V.  ...F. 

6-  2-15 

4th       1 

2 

1 

4 

5 

6 

7 

n 

n.  V.  A F. 

6-  3-  0 

2nd      1 

1 

; 

4 

-> 

6 

7 

0 

78.  T    L F. 

6-  3-  4 

7th       ] 

2 

^7 

4 

5 

7 

6 

0 

79.  "L.  P F. 

6-  3-  7 

4tli       ] 

1 

^ 

4 

0 

0 

0 

0 

80.  C.  C F. 

6-  3-  7 

1st       ■• 

-) 

^ 

0 

0 

4 

0 

0 

81.  V.  :\r.  ...F. 

6-  3-29 

2nd      ] 

1 

^ 

4 

7 

5 

6 

0 

82.  X.  D F. 

6-4-2 

1st        1 

7 

^ 

5 

4 

0 

0 

0 

83.  E.  S F. 

6-  4-22 

2nd      ] 

7 

^ 

4 

0 

0 

0 

0 

84.  E.  X F. 

6-  5-28 

7th       ] 

7 

3 

4 

5 

6 

7 

0 

85.  A.  M F. 

6-  6-15 

1st        ] 

7 

3 

4 

6 

^ 

7 

0 

%(y.  A.  B F. 

6-  6-20 

2nd      ] 

7 

3 

4 

;^ 

6 

7 

0 

87.  0.  P F. 

6-  7-  2 

2nd      1 

7 

3 

4 

5 

0 

0 

0 

88.  E.  R F. 

6-  7-  3 

4th 

7 

3 

4 

;^ 

6 

7 

0 

89.  B.  S F. 

6-  7-  7 

1st 

7 

3 

4 

7 

s 

s 

0 

90.  B.  S F. 

6-  7-  7 

2nd 

7 

3 

4 

7 

s 

s 

0 

91.  T.  F F. 

6-  9-  9 

1st 

7 

^ 

4 

^ 

6 

7 

0 

92.  "T.  F F. 

6-  7-15 

2nd 

7 

3 

/ 

^ 

4 

6 

0 

93.  E.  V F. 

6-  7-17 

1st 

7 

3 

4 

5 

7 

6 

0 

94.  ^r.  F.  C..F. 

6-  8-  8 

2nd 

2 

3 

4 

/ 

-t 

6 

0 

95  V.  G F. 

6-  8-10 

6th 

7 

3 

4 

5 

6 

7 

0 

96.  V  L F.. 

6-  8-11 

1st 

n 

3 

■" 

6 

4 

0 

0 

97.  X.  W.  ...F. 

6-  8-29 

1 

3 

4 

5 

6 

7 

0 

98.  G.  F F. 

6-  9-  9 

2nd      ] 

7 

3 

4 

5 

6 

7 

0 

99.  I.  E F. 

6-11-  2 

4th 

7 

3 

4 

T 

7 

6 

0 

100.  :\[.  S F. 

7-  0-  2 

1st 

7 

3 

4 

7 

0 

6 

0 

101.  T.  S.  C...F. 

7-  1-  2 

4th 

7 

3 

4 

^ 

7 

6 

0 

102.  M.  L.  B..F. 

7-  2-  5 

1st 

7 

3 

4 

5 

7 

6 

0 

103.  J.  B F. 

7-  2-20 

2nd 

2 

3 

4 

5 

6 

7 

0 

104.  D.  T F. 

7-  4-  0 

5th 

2 

3 

4 

5 

7 

6 

0 

105.  A.  T F. 

7-  4-21 

2nd 

2 

3 

_}. 

5 

6 

7 

0 

106.  M.  K.  ...F. 

7-  4-18 

3rd 

2 

3 

4 

^ 

6 

7 

0 

107.  :\r.  K.  ...F. 

7-  4-18 

4th 

9 

3 

4 

5 

g 

7 

0 

108.  M.  S F. 

7-  6-  4 

5th 

7 

3 

4 

^ 

6 

7 

0 

109.  A.  C F. 

7-  7-  0 

2nd 

7 

3 

4 

5 

6 

/ 

0 

110.  S.  P F. 

7-  7-  0 

7th 

2 

3 

4 

6 

/ 

5 

^  p  .4 

111.  S.  T F. 

7-  8-  6 

4tli 

7 

3 

4 

5 

6 

7 

0 

112.  S.  B F. 

7-  9-11 

4rh 

T 

0 

4 

^ 

6 

7 

0 

113.  V.  H F. 

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118.  ^r.  P F. 

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8-  8-18 

2nd     . 

8    P    ' 

42 


40.     J.  S.— Female,  14  years,  3  months,  21  days. 


41.     B.  E.— Female,  14  years,  6  months. 


Xame 


121.  B. 

122.  M. 

123.  M. 

124.  L. 

125.  E 

126.  E. 

127.  L. 

128.  E. 

129.  C. 
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131.  L. 
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133.  ^I. 

134.  T. 
1.35.  L. 
136.  K. 

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2.  Cx. 

3.  P. 
4. 'P. 

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7.  L. 

8.  G. 

9.  T. 

10.  A. 

11.  W 

12.  J. 

13.  J. 

14.  A. 

15.  R. 

16.  C. 


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17.  H.  C.  T., 

18.  E.  M.   ... 

19.  V.  P 

20.  H.  W.  . . . 

21.  L.  M 

22.  H.  M.  R.. 

23.  R.  Q 

24.  W.  B.  . . , 

25.  L.  X 

26.  R.  P 

27.  ^v.  D.  . . . 

28.  E.  K 

29.  C.  C 

30.  G.  S 

31.  T   C.  ^I.. 

32.  J.  S 


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33.  E.  ^r ^r.  5-  2-12     10th 


5     -^     :-5     ^      S      5      ^  R         Xucleus 

6              rS         £'•      i       =       E       F      =■      =■  •-         ''•   ^^   ^^■ 

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8-11-16      4th       1      2      3      4      5      6      7  0 

9-0-0      4th 8  P.  3 

9-8-6      4th     8  P.  2 

9-11-15      2nd      1       2      3      4      5      6      7  0 

9-11-16      5th     0 

10-0-  0      4th     8  P.  7 

10-5-27      2nd 8  ■    ' 

10-5-27       8  P.  5 

10-6-27       ■ 8  P.  4 

10-7-26      1st     0 

11-2-15       8  P.  7 

11-6-  4      3rd 8  P.  7 

11-8-  6      1st      8  P.  8 

12-1-  9      3rd -8  P.  6 

12-7-  9      3rd 8  P.  10 

44      1st       '''0000000  M.  1.5 

7-12      4th      1       0      000000  U.  .3 

7-19      5th      0      1       0      0      0      0      0  0  M.  3-U.  4 

1-  6-  6      5th      2      1      0      0      0      0      0  0  M.  9-U.  7-C.  3 

1-  9-10      1st       12      3      0      0      0      0  0  M.  6-U.  5 

2-  1-  7      3rd      1       2      0      0      0      0      0  0  V.  9-U.  8 

2-  7-19     12th       1      2      0      0      0      0      0  0  Ar.  8-U.  6 

3-  0-  5      1st       1      2      0      0      0      0      0  0  C.  3 

3-  9-17      1st       1       2      3      0      0      0      0  0  C.  5 
3-10-20      2nd      1      2      3      0      0      0      0  0  C.   5-S.  2 

4-  0-  0  3rd  1  2  -^  4  0  0  0  0  vr.  10-U.  8 
4-  1-17  1st  1  2  0  0  0  0  0  0  C.  6-Tm.  1 
4-  1-19  1st  12  3  0  0  0  4  0  M.  11-U.  9 
4-  2-24      2nd      1       2      0      0      0      0      0  0  C.  5 

4-  2-28      1st       1      2      3      0      0      0      0  0  C.  8-S.  7-Sc. 

4-  4-  3      2nd      12      3      4      5       0      6  0  3-Tm.  .8 

S.  4.2 

1       2030000  S.  2 

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4      0      0      5  0  3 

4      0      0      0  0  S.  5 

4      0      0      5  0  S.  3.5-Tm.  3 

4      0      0      5  0  S.  5 

4      0      0      0  0  S.  3 

0      0      0      0  0  ,Ar.  12-U.  10 

4      0      0      0  0  C.  7-S.  6 

0      0      0      0  0  C.  3 

1       2      3      4      0      0      0  0  S.  4.5 

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Tm.  4 

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44 


42.     J.  B.— Male,  17  years,  2  months. 


43.     J.  B.  E.  —Male,  17  years,  7  months,  14  days. 


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38.  T.  N M.  5-  3-  5  h-A 

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40.  E.  L M.  5-  3-11 

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43.  L.  F M.  5-  4-  9  1  st 

44.  AV.  L.   ...M.  S-  4-15  1st 

45.  R.  T M.  5-  4-26  .4th 

46.  T.  S ..M.  5-  5-  5  1st 

47.  T.  B M.  5-  5-12  1st 

48.  T.  R M.  5-  5-22  3rd 

49.  N.  K M.  5-  6-  3  1st 

50.  H.  C.  T..M.  5-  6-18  3rd 

51.  R.  E M.  5-  6-22  1st 

52.  A.  V.  CM.  5-  8-0  1st 

53.  T.  W M.  5-  8-17  ist 

54.  G.  S M.  5-  8-20  4th 

55.  A.  L M.  5-  8-25  9nd 

56.  G.  B M.  5-  8-29  5th 

57.  J.  T.  S...M.  5-  9-  6  4th 

58.  W.    D....M.  5-  9-26  9nd 

59.  W.   W....M.  5-10-  2  9nd 

60.  W.  M....M.  5-10-  3  1st 

61.  E.  T.  R..M.  5-10-  3  9„d 

62.  H.  C.  T..M.  5-10-20  1st 

63.  B.    D M.  5-11-19  ?nd 

64.  L.  S M.  6-  0-  2  9nd 

65.  E.   M M.  6-  0-  4  1st 

66.  T.  D M.  6-  0-  9  2nd 

67.  R.  G.   S..M.  6-  0-25  1st 

68.  G.  B.D...M.  6-  1-  0  3rd 

69.  G.   M M.  6-  1-  0  4th 

70.  T.  W M.  6-  1-  2  7th 

71.  R.   P M.  6-  1-11  8th 

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73.  S.  H M.  6-  1-20  4th 

74.  S.    P.....M.  6-  1-28  3rd 

75.  T.   T M.  6-  2-11  1st 

76.  O.    S M.  6-  2-  1  1st 

77.  E.   B M.  6-  2-  6  1st 

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C.  2 

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Tm.   6.5 

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S.  7 

Tm.   .8 

S.  6 

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46 


44.     C.  S.— Male,  6  years,  8  months,  19  days 


45.     J.  S. — Male,  7  years,  3  months. 


Name. 


79. 

80. 

81. 

82. 

83. 

84. 

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86. 

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89. 

90. 

91. 

92. 

93. 

94. 

95. 

96. 

97. 

98. 

99. 
100. 
101. 
102. 
103. 
104. 
105. 
106. 
107. 
108. 
109. 
110. 
111. 
112. 
113. 
114. 
115. 
116. 
117. 
118. 
119. 
120. 
121. 
122. 
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126. 
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43 


46.     M.  W.— Female,  6  years,  6  days. 


47.     J.  W.— Male,  7  years,  10  months,  14  days. 


49 


S      £      5      S     i     -S     .5  E  ^.Size 

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S^          ^  :5  .=3      =      5      i      S      S      2  .;£ 

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129.  L.    F M.  9-  8-  7  3rd  1       2      3      4      5      6      7  0 

130.  L.  B.  AI..M.  9-  9-14  7th  1      2      3      4      7      6      5  0 

131.  P.   C M.  9-10-  8  2nd 0 

132.  C.   R AI.  9-11-  4  4th     0 

133.  T.   M M.  9-11-26  1st  12      3      4      5      6      7  0 

134.  E.   E M.IO- 4-13  1st      0 

135.  W.   S M.IO-  5-13  4th  1      2      3      4      5      6      7  0 

136.  H.    F M.IO-  5-16  3rd     .. 0 

137.  W.  E M.IO-  7-10  4th     0 

138.  S.  F M.  10-8-0  3rd 0 

139.  W.  T....M.  10-  9-  0  1st  ..     ..       3      4      5      6      7  0 

140.  B.    B . . . .  M.  11-  0-  4  f  th     0 

141.  W.    T....M.11-  3-  3  ...  1      2      3      4      6      5      7  0 

142.  F.   R M.  11-3-23  6th     0 

143.  B.    T M. 11-  4-22  3rd 0 

144.  H.    F....M.  11-  8-  0  1st      8     P.  2 

145.  C.  W....M.  12-  6-  0  4th     0 

146.  W.  C....M.  12-  6-24  1st      0 

147.  R.   F M.  12-  9-  4  2nd 8     P.  10 

148.  D.   V. . . . M.  12-10-  0  8     P.  5 

149.  E.   M....M.  12-10-21  1st      0 

150.  R.  W. . . . M.  13-  0-  6  4th     0 

151.  E.    P M.  13-7-25  6th     8     P.  8 

152.  E.    S M.13-9-5  1st     8     P.  6 

153.  J.   F M.  14-  0-16  4th     0 


The  chronological  order  in  which  the  bones  of  the  human  carpus 
are  ossified  is  as  follows:  1,  Os  Magnum.  2,  L^nciform.  3,  Cunei- 
form. 4,  vSemilunar.  5,  vScaphoid.  6,  Trapezoid.  7,  Trapezium. 
8.  Pisiform. 

In  a  summary  of  the  table  we  find  that  in  two  hundred  and  forty- 
one  (241)  hands  there  is  good  evidence  that  the  magnum  appeared 
first  two  hundred  and  thirty-six  (236)  times  and  the  unciform  five 
(5)  times.  In  two  hundred  and  forty-one  (241)  hands  the  unciform 
appeared  first  in  five  (5)  instances  and  the  magnum  two  hundred  and 
thirty-six  (236)  times. 

In  those  hands  in  which  the  cuneiform  had  made  its  appearance 
it  came  in  the  third  place  two  hundred  and  nineteen  (219)  times,  and  in 
the  fourth  place  ten  (10)  times.  You  will  observe  that  the  cuneiform 
is  not  displaced  by  any  of  the  other  bones  except  the  semilunar,  which 
appeared  in  the  third  place  twelve  (12)  times,  and  in  its  own  position, 


50 


48-     G.  G. — Female,  4  years,  6  months,  7  days. 


49.     S.  G.— Female,  5  years. 


51 

the  fourth,  one  hundred  and  seventy-six  (176)  times.  Eight  (<S) 
times  in  the  fifth  position,  twice  (2)  in  the  sixth,  and  six  (6)  times 
in  the  seventh  place,  in  a  total  of  two  hundred  and  four  (204) 
instances. 

In  one  hundred  and  twenty-nine  ( 129)  hands  we  find  the  scaphoid 
has  appeared.  Of  this  number  it  appeared  three  (3)  times  in  the 
fourth  position,  eighty  (80)  times  in  the  lifth,  twenty-seven  (27) 
times  in  the  sixth  and  ninteen  (19)  times  in  the  seventh  place. 

The  table  shows  one  hundred  and  twenty-four  ( 124)  hands  in 
which  the  trapezoid  presents  a  point  of  ossification  or  a  very  large 
nucleus.  In  eight  (8)  instances  it  appeared  in  the  fourth  place,  thirty- 
six  (36)  times  in  the  fifth,  fifty-nine  (59)  times  in  the  sixth,  and 
twenty-one  (21)  times  in -the  seventh  position. 

The  trapezium  made  its  appearance  seven  (7)  times  in  the  fourth 
position,  thirty  (30)  times  in  the  fifth,  thirty-one  (31)  times  in  the 
sixth,  and  fifty-one  (51)  times  in  its  own  position,  that  of  the  seventh. 

There  are  ninteen  ( 19)  showing  a  nucleus  of  ossification  in  the 
pisiform,  all  appearing  in  the  eighth  position.  This  may  be  more 
distinctly  seen  in  the  form  of  a  summary. 

SUMMARY. 


First  

.   236 

5 

Second  

5 

236 

Third  

2i9 

12 

Fourth  

10 

176 

3 

8 

7 

Fifth 

8 

80 

36 

30 

Sixth  

2 

27 

59 

31 

Seventh  .. . . 

6 

19 

21 

51 

Eighth  

\9 

Total.... 

.   241 

241 

229 

204 

129 

124 

119 

19 

If  my  conclusions  are  correct  in  placing  them  in  the  order  in 
which  they  are  found  in  the  table,  and,  as  I  have  said,  I  have  used 
only  those  in  which  the  order  was  distinct ;  there  can  hardly  be  a 
question  that  the  chronological  order  of  ossification  is  in  accordance 


52 


50.     P.  L.— Female,  3  years,  10  months. 


51.     A.  L.— Male,  5  years,  8  months,  25  days. 


53 

with  this  table.  It  ^^•ill.  however,  be  seen  there  are  all  kinds  of  vari- 
ations, or  what  might  be  called  combinations ;  thus,  the  magnum  or 
unciform  may  be  found  in  either  the  first  or  second  positions,  but 
they  are  never  displaced  by  any  of  the  other  bones. 

The  cuneiform  is  rarely  displaced  from  the  third  position,  and 
then  only  by  the  semilunar.'  The  latter  bone  has  a  strong  hold  on  the 
fourth  place,  but  it  may  be  found  in  the  third,  fifth,  sixth  or  seventh 
positions  ;  that  is,  in  exceptional  instances. 

The  scaphoid,  trapezoid,  and  the  trapezium  frequentlv  exchange 
positions. 

Fig.  22  represents  the  order  in  which  the  average  will  occur,  viz. : 
\,  OS  magnum.  2,  unciform.  Z,  cuneiform.  4,  semilunar.  5,  scaphoid. 
6,  trapezoid.    7,  trapezium.    8,  pisiform. 

In  Fig.  12,  we  have  an  instance  in  which  the  unciform  is  found 
in  the  first  position,  preceding  the  magnum.  Fig.  -13  is  the  same  hand 
taken  eleven  months  later.  The  magnum  evidently  appeared  soon  after 
that  of  the  unciform,  but  has  not  had  sufficient  time  for  its  nucleus  to 
grow  larger  than  the  last  named  bone.  In  Fig.  23,  the  semilunar  has 
appeared  in  the  third  position  in  advance  of  the  cuneiform.  Fig.  24 
shows  the  scaphoid  has  preceded  the  semilunar  and  is  found  in  the 
fourth  position ;  and  in  Fig.  25  the  trapezoid  is  in  the  fourth  position 
with  the  semilunar  fifth. 

The  next  illustration,  viz. :  Fig.  26,  shows  a  different  order  of 
ossification,  in  which  the  trapezoid  is  fifth,  trapezium  sixth,  and 
scaphoid  seventh.  Fig.  27  shows  the  trapezium  in  the  fifth  position, 
and  trapezoid  sixth,  and  Fig.  28  has  the  trapezoid  fifth,  trapezium 
sixth  and  scaphoid  seventh.  In  Fig.  29  the  trapezium  is  fifth,  trape- 
zoid sixth  and  scaphoid  seventh.  Fig.  30  shows  a  very  unusual  order 
of  ossification.  The  trapezoid  is  in  the  fourth  position,  trapezium 
fifth,  scaphoid  sixth,  and  semilunar  seventh.  These  may  be  more 
graphically  shown  when  grouped,  or  in  tabluar  form,  as  follows : 


54 


52.     W.  L. — Male,  5  years,  4  months,  15  days. 


53.     W.  L.  — Male,  6  years,  10  months,  16  days. 


Name. 


.  22— N. 
.  12— P. 
.  13— P. 
.  23— H. 
.  24— E. 
,  25— J. 
,  26— E. 

27—1. 
,  28— V. 
,  29— A. 
.  30— M. 

31-J. 


W 

M, 

M 

C. 

T. 
B., 

C, 
M. 

C, 

P., 
R., 
P., 


T., 
R, 


6-2-15 1 

0 
2 


M . . 

..       8-25 

M.. 

..1-6-6 

M . . 

..6-  4-25 

M.. 

..5-10-  3 

F... 

..6-0-0 

F... 

...5-  9-14 

F... 

...5-  1-12 

F... 

..5-10-14 

F... 

..5-6-1 

F... 

..5-1-9 

M.. 

..6-  3-0 

In  arriving  at  these  conclusions,  a  number  of  factors  are  to  Idc. 
taken  into  consideration.  The  rate  of  growth  varies  in  different 
famihes.  In  some  famihes  the  bones  ossify  with  much  greater  rapidity 
than  others.  Condition  of  health,  accidents,  disease,  anything  that 
would  interfere  with  the  blood  supply  or  modify  metabolism,  would 
be  likely  to  delay  or  modify  the  process  of  ossification. 

The  shadow  of  the  nucleus  is  somewhat  larger  than  the  object, 
and  the  conditions  under  which  the  exposures  are  made  should  be 
uniform,  such  as  the  distance  of  the  tube  from  the  plate,  the  time  of 
exposure  and  the  development  of  the  plate,  should  all  be  considered. 
Making  all  possible  allowance  for  errors  on  account  of  these  factors, 
and  using  such  cases  in  which  I  have  obtained  negatives  showing  min- 
ute points  of  ossification;  then  making  subsequent  exposures  of  these 
hands  at  frequent  intervals,  one,  two  or  more  months  apart,  I  have  been 
able  to  approximate  the  rate  of  growth.  Then  taking  the  size  of  the 
nucleus  in  m.  m.,  we  can  estimate  the  times  of  appearances  with  as 
much  freedom  from  error  as  could  be  determined  by  other  methods. 

Fourth. — The  bones  of  the  first  child,  as  a  rule,  ossify  sooner  than 
those  of  subsequent  children.  While  we  have  some  evidence  of  this, 
it  is  not  uniform  by  any  means,  and  I  am  disposed  to  qualify  this 
statement  until  I  have  thoroughly  investigated  this  side  of  the  ques- 
tion. 

Fifth. — Regardless  of  the  variation  (normal)  the  ossification  is 
bilaterally  symetrical. 

I  have  but  to  call  your  attention  to  Figs.  32  to  39  in  substantiation 


56 


54.     L.  B.  M.— Male,  9  years,  9  months,  14  days. 


55.     R.  M.-Male,  8  years,  2  months,  25  days. 


of  this  statement.  It  is  true  that  an  occasional  ditlerence  in  the  develop- 
ment in  the  two  hands  may  he  seen,  hut  where  one  difference  may  he 
seen  very  many  points  of  similarity  exist. 

Sixth. — The  union   of   the  epiphyses   with   the   shaft   takes   place 
much  sooner  than  formerlv  supposed. 

I  oft"er  but  few  illustrations  of  this,  but  the  examples  given  are 

sufficient   to   make   the   statement   conclusive   in   connection    with   the 

examination  of  a  large  number  of  hands,  between  the  ages  of  twelve 

and  twenty-two. 

UXIOX  OF  EPIPHYSES. 

Phalanges    j  female  :       15  to  16  years. 

(  Male:  1/  to  18  years. 

Metacarpal   j  female        15  to  16  years. 

^  (  Alale  1/  to  18  years. 

Lower  Epiphysis   of   Radius ■....-.  {  Ff'^^le        17  to  IS  years. 

/  -Male  18  to  21  years. 

Lower   Epiphysis   of   Ulna {  ^>7^1^        J^  to  17  years. 

(  -^lale  1/   to  20  years 

EXAMPLES. 
Phalanges  and  Aletacarpal. 
Female.  ^ilale. 

14..3  all  united,   faint  line  of  proximal       16.4  ungual,  united, 
epiphysis   of  thumb.  17.2  all  united. 

14.4  all  united.  16  g    "         " 

14.5  "  •'  ^y\  . 

14.6  "  '  •  , 

14.7  "  "  17.1 
14.6   "  "  17.5  " 
14.10"  "  17.6  " 

14.10-;      ;;  i7.6  <^      « 

15.6   "         "  '-^■^ 

15.6   "         "  17.9   '•         " 

15.8-  "         "  17.11  •• 

.Ml  united  at  sixteen.  All   united  before   18. 

LOWER  EPIPHYSES  OF  RADIUS  AXD  ULXA. 

Female.  ?»Iale. 

Ulna.  Radius.                                Ulna.                          Radius. 

14.10 — united.  Distinct  line.  17     — united.             *Faint  line. 

16.2  —     "  Faint  line.  17.2  —     " 

16.3  —     "  "         "  17.6  —     " 

16.4  —     "  "         "■  18.    —     '•■ 
16.9  —     "  "         "  18.    —     " 

16.9  —     "  United.  18.5  —  "  United. 

All  after  17.  A     few    with     faint       18.6  —  " 

line  after  18.  18.9  —  " 

18.10—  " 

19.1  —  •' 

1^.3  —  " 

19.3  —  •• 


58 


^ 


56.     W.  M.— Male,  7  years,  3  months,  27  days. 


57.     E.  M.  — Male,  7  years,  5  months,  5  days. 


59 

Scziiiih. — \'ariations  in  tie  ossification  of  bones  is  a  heritable 
trait. 

My  belief  that  normal  ossification  of  bones  present  evidence  of 
heredity  is  based  upon  the  fact  that  we  n^ay  find  similar  conditions  in 
the  chronological  order  of  ossification  of  the  bones  of  the  carpus,  and 
when  extra  epiphyses  are  found  to  be  present,  they  are  found  in  the 
hands  of  the  brothers  and  sisters. 

I  have  only  met  with  a  few  instances  in  which  there  was  an 
extra  epiphysis  present.  Such  as  that  occasionally  found  at  the  prox- 
nnal  extremity  of  the  metacarpal  bone  of  the  index  finger.  Unfortun- 
ately when  I  did  find  this  extra  epiphysis  present,  they  were  in  most 
instances  the  only  children  of  the  parents,  and  I  have  not  been  able  to 
follow  the  families. 

I  have  had  abundant  opportunity  to  observe  the  similarity  of 
the  order  of  ossification  of  the  bones  of  the  carpus  in  the  hands  of 
brothers  and  sisters.  I  have  followed  these  cases  through  a  number 
of  years.  In  some  instances  I  have  made  examinations  several  times 
during  the  year,  and  when  necessary,  during  a  period  of  several  years 
in  succession,  in  order  to  obtain  results. 

It  will  be  seen  from  the  following  table  there  may  be  a  number  of 
variations  from  the  usual  order,  and  it  is  this  variation  I  find  to  be  a 
heritable  trait. 

When  I  submitted  the  result  of  the  examinations  of  my  first 
ten  families,  I  thought  there  were  no  exceptions,  but  a  later  examin- 
ation of  several  of  these  same  cases  gave  dift'erent  results. 


60 


58.     L.   H.— Female,  5  years,  5  months,  25  days. 


59.     N.  H.— Male,  6  years,3   months,  10  days. 


61 


^■ 

C 

•6 

r-' 

^ 

-73 

^- 

rH 

u, 

<— 

.^ 

C 

Name. 

D 

s 

O 

0^ 

o 

m 

y                  Mo 

CO 

re 
o 
CO 

t^ 

i^ 

'p^ 

44(C.  S 

....M. 

6-  8-19        1 

2 

3 

4 

0 

5 

6 

0 

45  1  J.  S 

. . . .  M. 

7-3-0        1 

2 

3 

4 

0 

5 

6 

0 

46  ni.  W 

F. 

6-0-6        1 

2 

3 

4 

6 

5 

7 

0 

47  U.  W 

....  M. 

7-10-14        1 

9 

3 

4 

6 

5 

7 

u 

48fG.  G 

....F. 

4-6-7        1 

2 

3 

6 

5 

7 

4 

0 

491  S.  G 

. . . .  F. 

5-0-1        1 

2 

3 

6 

5 

7 

4 

0 

50' r  P.  I 

5M  A.  L 

F. 

3-10-  0        ] 

9 

4 

3 

0 

i 

0 

u 

....M. 

5-  8-25        1 

7 

4 

3 

6 

5 

0 

0 

52 

W.  L 

....M. 

5-  4-15        1 

2 

4 

3 

0 

5 

0 

0 

53 

W.  L 

....M. 

6-10-16        1 

2 

4 

3 

6 

5 

7 

0 

54 

'  L.  B.  M 

....M. 

9-  9-14        1 

2 

3 

7 

6 

5 

0 

55  -j 

R.  ^I 

....  M. 

8-  2-25        1 

2 

3 

4 

0 

6 

5 

u 

56 

W.  M 

....  M. 

7-  3-25        1 

2 

3 

4 

6 

0 

0 

0 

57 

E.  M 

....M. 

7-  5-  5        1 

2 

3 

4 

6 

0 

S 

0 

58  IL.  H 

....F. 

5-  5-25       .1 

2 

3 

/ 

4 

6 

5 

0 

59  1  N.  H 

....M. 

6-  3-10        1 

2 

3 

5 

4 

0 

0 

0 

60  (  E.  W 

....F. 

3-  6-21        1 

2 

3 

4 

6 

0 

0 

0 

6nH.  W 

62  [  S.  F 

....M. 

S-    2-21             : 

9 

3 

4 

0 

0 

b 

0 

F. 

6-  0-16        1 

2 

3 

4 

5 

0 

6 

0 

63  1  A.  F 

. . . .  M. 

6-11-22        1 

2 

3 

4 

5 

0 

6 

0 

64  f  P.  M 

. . . .  M. 

3-10-16        1 

2 

0 

0 

0 

0 

0 

0 

65  ^  G.  M 

...M. 

6-1-0        1 

2 

3 

4 

5 

0 

0 

0 

66  I  R.  M •. ... 

F. 

8-  1-16        1 

2 

3 

4 

b 

6 

7 

u 

68(H.  F 

....M. 

6-6-4        ] 

2 

0 

3 

0 

0 

0 

0 

69  1  W.  F 

M. 

5-  2-29        ] 

2 

0 

0 

0 

0 

u 

0 

The  above  table  includes  ten  families  in  which  I  had  the  oppor- 
tunity of  observing  the  hands  of  two  or  more  children,  all  of  which 
are  illustrated  in  this  article.  I  have  the  records  of  thirteen  other 
families  of  two  or  more  children  which  show  hereditary  characteristics 
just  as  pronounced  as  those  herewith  presented. 

Figs.  44  and  45  are  the  hands  of  brothers  following  the  same 
line  of  ossification  of  the  bones  of  the  carpus,  in  which  we  see  the 
trapezoid  in  the  fifth  position,  followed  by  the  trapezium,  and  both 
have  preceded  the  scaphoid. 

In  the  next  pair.  Figs.  46  and  47.  a  brother  and  sister,  the  trape- 
zoid is  in  tlie  fifth  position  followed  by  the  scaphoid  in  the  sixth,  and  the 
trapezium  seventh. 

Figs.  48  and  49  are  sisters,  in  which  the  trapezium  is  in  the  fourth 
position,  scaphoid  fifth,  semilunar  sixth,  and  the  trapezoid  in  the 
seventh  place,   while   Figs.   50  to   53   are  hands  of  a   sister  and  two 


62 


\a 


60.     E.   W. — Female,  3  years,  6  months,  21  days. 


f'i-} 


61.     H.  W.  —  Male,  5  years,  2  months,  21  days. 


63 

brothers,  in  which  ihe  stmilur.ar  preceded  the  cuneiform,  appearing 
in  the  third  position,  thus  placing  the  cuneiform  fourth,  the  trapezoid 
fifth,  and  scaphoid  sixth.  Several  views  were  taken  of  each  of  these 
hands  at  different  times,  and  covering  a  period  of  several  years. 

The  next  set  are  four  brothers,  Figs.  54  to  57.  The  first  two 
show  the  same  line  of  development  with  the  trapezium  fifth,  the 
trapezoid  sixth  and;  scaphoid  seventh.  The  next  two  brothers  in  the 
family  show  a  somewhat  d'ifl:"erent  line  of  development.  While  the 
trapezium  is  still  in  the  fifth  place,  the  scaphoid  has  taken  the  sixth, 
and  the  trapezoid  has  not  appeared,  but  will  be  found  later  on  in  the 
seventh  position. 

This  is  the  only  opportunity  I  have  had  to  observe  four  children 
of  the  same  family.  The  first  two  were  the  seventh  and  eighth  children, 
and  the  second  two  were  the  ninth  and  tenth  children. 

It  would  appear  from  a  study  of  this  set  that  these  characteristics 
were  of  a  Mendelian  nature. 

You  will  see  similarities  in  each  of  the  other  groups  represented  by 
Figs.  58  to  63. 

Figs.  64,  65  and  66  are  the  hands  of  two  brothers  and  a  sister 
in  which  we  see  a  proximal  epiphysis  to  the  metacarpal  bone  of  the 
index  finger  in  each  hand.  A  number  of  exposures  w^ere  made  of  each 
of  these  hands,  covering  a  period  of  about  five  years.  Figs.  12  and  13 
are  the  same  hand  as  64.  We  see  the  early  appearance  of  ossification 
in  the  epiphysis  in  Fig.  13,  while  in  Fig.  64  is  uniting  with  the  shaft. 
Each  of  these  hands  show  a  scale-like  epiphysis  at  the  distal  extremity 
of  the  metacarpal  bone  of  the  thumb. 

The  last  two  illustrations.  Figs.  68  and  69,  are  the  hands  of 
brother,  five  years  and  two  months  of  age,  and  six  years  and  six 
months  of  age  respectively. 

Each  of  these  show  a  very  slow  development.  I  would  judge  this 
to  be  a  family  characteristic. 


64 


62.     S.   F.  — Female,  6  years,  16  days. 


63.     A.  F.— Male,  6  years,  11  months,  22  days. 


65 


64.     P.   M.— Male,  3  years,  10  months,  16  days. 


65.     G.   M.— Male,  6  years,  1  month. 


66 


*S,  I  ^ 


,.-«<>"■• 


,^.    iW|. 


>^- 


66.     Jl.  M.  — Female,  8  years,  1  month,  6  days. 


67.     L.  D. — Female,  15  years,  6  months,  2  days. 


67 


■i,Ai' 


iy 


68.     H.  F.^Male,  6  years,  6  months,  4  days. 


•  -^^V.-, 


69.     W.   F.— Male,  5  years,  2  months,  29  days. 


COLUMBIA  UNIVERSITY  LIBRARIES     , 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing,  as 
provided  by  the  rules  of  the  Library  or  by  special  arrange- 
ment with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

C28(lI4t)M100 

QM117                      P95 

Pryor 

Some    observations  on  the  oRsifi- 

/ 

cation 

of  the  bones  of  the  hand. 

